BEHAVIORAL HEALTH OF PARENTS/CAREGIVERS: IMPACT ON CHILDREN IN CHILD WELFARE SYSTEM

2. BEHAVIORAL HEALTH OF PARENTS/CAREGIVERS: IMPACT ON CHILDREN IN CHILD WELFARE SYSTEM Pamela S. Hyde, J.D. SAMHSA Administrator Regional Partnership Grantee Kickoff Meeting Washington, DC • January 23, 2013

3. SAMHSA’S VISION • A nation that acts on the knowledge that: • Behavioral health is essential to health • Prevention works • Treatment is effective • People recover A nation/community free of substance abuse and mental illness and fully capable of addressing behavioral health issues that arise from events or physical conditions

4. IMPACT: CHILD MALTREATMENT AND BEHAVIORAL HEALTH • 23 percent of children age < 17 who have experienced maltreatment have behavior problems requiring clinical intervention • 35 percent of children age < 17 who have experienced maltreatment demonstrate clinical-level problems w/social skills – more than twice the rate of the general population Child Maltreatment 2010: Data from the National Child Abuse and Neglect Data System estimates 695,000 children were found to be victims of child maltreatment (754,000 incidents)

5. IMPACT: PARENTS WITH SUDs • ~Six million children (9 percent) live w/at least one parent w/SUD • 1/3 of child welfare cases in which child remained in parent’s custody • 2/3 of cases in which the child was removed • 10 to 15 percent: infants exposed to substances during pregnancy • Majority of parents entering publicly-funded SA Txare parents of minor-age children • 59 percent: Had a child  age 18 • 22 percent: Had a child removed by CPS • 10 percent: Lost parental rights once child was removed

6. FOSTER CARE AND BEHAVIORAL HEATLH Clinical-level behavior problems are ~3 x as common among foster care youth as general population Among children who enter foster care, ~⅓scored in clinical range for behavior problems on Child Behavior Checklist Children in foster care more likely to have a MH diagnosis than other children Foster youth between 14 and 17: 63 percent met criteria for at least one MH diagnosis at some point in life

7. IMPACT: CHILDREN AND TRAUMA • > 6 in 10 U.S. youth have been exposed to violence in past year; nearly 1 in 10 injured • Trauma disrupts normal development, has lasting impact, and becomes intergenerational • Brain development, cognitive growth, and learning • Emotional self-regulation • Attachment to caregivers and social-emotional development • Predisposes children to subsequent psychiatric problems • Adverse Childhood Experiences (ACEs) potentially explain 32.4 percent of M/SUDs in adulthood • ¼ of adult mental disorders start by age 14; ½ by age 25

8. REPORTED PREVALENCE OF TRAUMA IN BH • Majority of adults and children in inpatient psychiatric and substance use disorder treatment settings have trauma histories 43 – 80 percent: Individuals in psychiatric hospitals have experienced physical or sexual abuse 51 – 90 percent: Public mental health clients exposed to trauma >70 percent: Adolescents in SU Tx had history of trauma exposure

9. INTERGENERATIONAL • ⅔ adults in SUD Tx report being victims of child abuse and neglect • Women w/SUDs more likely to report a history of childhood abuse Many women w/SUDs experienced physical or sexual victimization in childhood or in adulthood and suffer from trauma Alcohol or drug use may be a form of self-medication for people w/trauma or mental health disorders

10. TRANSITION AGE YOUTHTOUGH REALITIES – YOUNG PEOPLE DIE

11. TREATMENT IS EFFECTIVE Need to ↑ understanding effective treatments exist for BH problems and trauma symptoms common among children in child welfare system Need to promote ↑ use of evidence-based screening, assessment, and treatment Need to ensure appropriate use of psychotropic medications while ↑ availability of evidence-based psychosocial treatments Need to ↑ access to non-pharmaceutical treatment to ↓ potential for over-reliance on psychotropic medication as a first-line treatment strategy

12. BUILDING ON LESSONS LEARNEDRPGs PAST 5 YEARS Project leadership: Engaging and sustaining partners in the process Identifying opportunities for change: Be problem focused and data driven Establishing shared outcomes and joint accountability Implementing and sustaining system-level changes

13. EXPAND YOUR RESOURCES → EXPAND YOUR REACH National Center on Substance Abuse and Child Welfare: Improving systems and practice for families w/SUDs who are involved in the child welfare and family judicial systems National Child Traumatic Stress Network: ↑ standard of care and improve access to services for traumatized children, their families, and communities National Center for Trauma Informed Care: ↑ awareness of trauma-informed care and promote implementation of trauma-informed practices in programs/services BRSS TACS: T/TA to States, providers, and systems to ↑ adoption and implementation of recovery supports (e.g., peer-operated services, shared decision making, supported employment) for people w/BH problems NREPP: Searchable online registry of 260+ interventions supporting MH promotion, SA prevention, and MH/SA Tx

14. SHAPING THE FUTURE TOGETHERBUIDLING ON THE FACTS BH is a public health issue, not a social issue BH problems lead to premature death and disability BH problems impose steep human and economic costs BH impacts physical health Government policies often inappropriately treat BH as optional/extra Many M/SUDs can be prevented Early intervention can reduce impact of BH problems Treatment works, but is inaccessible for many Treatment needs to be about families BH is community health - it affects everyone